Author Information

Hyojin Song,

Michelle Kittleson,

Jignesh Patel,

Matthew Rafiei,

Ashley Osborne,

David Chang,

Danny Ramzy,

Antoine Hage,

Lawrence Czer and

Jon Kobashigawa

Background

The average Cylex score (CS) is lower in heart transplant (HTx) patients (pts) prior to infectious episodes, but the impact of a change in CS on the risk of subsequent infection is not known. The purpose of this study was to determine if a change in CS in HTx pts would impact the risk of subsequent infections.

Methods

We evaluated 1,567 pairs of CS from 331 HTx pts in their 1st yr. CS < 200 was low and CS ≥ 200 was normal. Pts were divided based on the change in CS: low CS to low CS (Group 1), normal CS to low CS (Group 2), low CS to normal CS (Group 3), and normal CS to normal CS (Group 4). The two groups with a subsequent normal CS (Groups 1 & 2) were combined into Group A. The two groups with a subsequent low CS (Groups 3 & 4) were combined into Group B. Infectious episodes within 2 months after the subsequent CS were recorded.

Methods

The risk of future infection was highest in pts in Group 2 (normal to low CS) at 12.5% and lowest in Group 4 (normal to normal CS) at 4.7%. Group A pts (subsequent low CS) had a 47% higher rate of infection than Group B pts (subsequent normal CS; 9.2% vs 4.9%, p=0.001). Infections were viral (n= 14), bacterial (n= 14), fungal (n= 12), parasitic (n=2), and other (n= 5). Average time to infection for Groups A and B were similar (18 ± 23 days vs 26 ± 23 days, p=0.116).

Cylex Group

Any-Treated Infection

Group A

52/566 (9.2%)

Group 1, n (%) (CS < 200, CS < 200)

22/326 (6.8%)

Group 2, n (%) (CS ≥ 200, CS < 200)

30/240 (12.5%)

Group B

49/1,001 (4.9%)

Group 3, n (%) (CS < 200, CS ≥ 200)

12/216 (5.5%)

Group 4, n (%) (CS ≥ 200, CS ≥ 200)

37/785 (4.7%)

P-value

0.001

Conclusion

Maintaining CS > 200 is associated with a 47% reduction in infection risk compared to CS < 200. Thus, tailoring immunosuppresion to maintain CS > 200 may prevent infections in HTx pts. Further study is needed to confirm these findings.

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